Chapter 56 Care of the patients with HIV/AIDS

Early S/S of HIV

occur when the CD4 cell count drops below 500/mm; fever, fatigue, headaches, swollen lymph nodes, skin rash, NVD, sore throat, night sweats

HIV- Stage 1

occurs within 2-4 weeks of infection flu like symptoms very infectious with elevated numbers of virus in fluids

Phase 5: Replication

once integrated into the CD4 cell DNA, HIV begins to use the machinery of the CD4 cell to make long chains of HIV proteins, The protein chains are the building blocks for more HIV

HIV- Stage 3

patient develops AIDS most severe stage develops opportunistic infections viral loads elevated and very contagious CD4 count <200cell/mm fever, chills, swollen lymph nodes, weight loss, weakness

HIV is found in

pericardial, synovial, cerebrospinal, peritoneal, amniotic fluids

late signs and symptoms of HIV

persistent high fever, severe chills, white spots in mouth, severe fatigue, brown red purple or pink rashes, significant weight loss

Multidisciplinary Care for HIV patients

physician who specializes in HIV disease social worker case manager dietitian nurse mental health professional

Seroconversion

point at which you can detect antibodies to HIV usually 1-3 weeks after infection

Physician

prescribes medications antiretroviral therapy monitor viral load monitor lab values

Nursing interventions for HIV pts

prevention of infection, modify alternations in body temperature, promote good nutrition, promote self care, and provide counseling

HIV treatment

prevents immune system damage limiting viral loads to undetectable levels

Karposi sarcoma

rare cancer of the skin and mucous membrane characterized by blue, red, purple raised lesions; occurs in Mediterranean men

CD4 (Tcell) count

reflects number of CD4+ cells per cubic millimeter(microliter) of blood used to measure a persons immune function normal values range between 500 and 1500 cells per cubic millimeter

HIV modes of transmission

sexual intercourse (most common) anal/vaginal IV drug use Infected blood, semen, rectal secretions, cervi-covaginal secretions, breast milk

Proper PPE for HIV

standard precautions unless at risk for blood or body fluids. If so the nurse would don mask with face shield or goggles, gloves, gown

1985

start of blood screening for HIV 1

1992

start of screening for HIV 2

CD4 count

test that measures how many CD4 cells you have in your body. These are a type of wbc called T Cells that moves throughout your body to find and destroy bacteria, viruses, other invading germs

What levels go down in me with aids

testosterone

Viral Load

the amount of measurable HIV present in an infected person's blood

AIDS stage

the host can no longer protect itself and body is injured CD4+ count decreases to fewer than or equal to 200 cells/mm number of viruses detectable in blood increases rapidly without treatment, the median time for AIDS diagnosis to death 1 1/3 years

Drug Resistant ART

-HIV mutates easy, makes treatment/containment hard -Mutation is why there is no vaccine -During acute stage important to test for resistance to make sure appropriate ART is administered -Patient specific combination -patient commitment to taking ART at correct time, dosage is a must to prevent resistance

HIV antibody tests

-antibodies to HIV develop in an infected individual within as little as 3 weeks to as much as 14 months after exposure to virus -person can falsely test negative for the virus during this time

Opportunistic Diseases

-candidiasis of bronchi,trachea,esophagus,;lungs -invasive cervical cancer -coccidioidomycosis-valley fever(fungus infection) -cryptococcosis(yeast like fungus) -cryptosporidiosis(parasite), chronic intestinal(greater that 1 month duration) -Cytomegalovirus(virus in the herpes family)(particularly CMV retinitis) -Encelphalopathy, HIV related -Herpes Simplex

Testing for HIV Legal Implications

-informed consent must be obtained prior to testing -pre and post test counseling(usually by state approved HIV counselor) is required regardless of the results -results can not be given over phone. -ensuring client confidentiality is essential; labs use coding instead of patient name -lab musty be approved by state for HIV testing

route of expsoure

-initial exposure -Primary HIV infection(acute illness)- flulike symptoms, develop antibodies to HIV in 1-2 weeks -Asymptomatic(HIV seropositivity) infectious but no eveidence of illness except positive result -Early HIV disease- persistent unexplained fever, night sweats, diarrhea, weight loss, fatigue, lymphadenopathy; signs and symptoms may not occur until 10-14 years after initial exposure without treatment -Advanced HIV disease- AIDS

ART side effects

-severe gastrointestinal upset with nausea, vomiting, diarrhea -Bone marrow suppression - Peripheral Neuropathy - Diabetes - Increased cholesterol - Increased triglyceride levels

CD4 count of AIDS

200 OR LESS

Cocktail

3 or more compounds that are effective in treating HIV/AIDS

Time line of hiv antibodies

3 weeks to 14 months; can test false

Normal CD4 count

500-1500

Infant is HIV tested

6 weeks after birth

Nutrition

Diarrhea-lactose free, low fat,low fiber, high potassium Constipation- high fiber food Nausea/vomiting- low fat foods Candidiasis- soft/ pureed food fever- high calorie, high protein food altered taste-diet as tolerated anemia- high iron food fatigue- high calorie

Lab results identifying progression of HIV

CD4 count, antibody testing, viral load testing

OraQuick Rapid HIV-1 Antibody test

Detects antibodies to HIV-1 in home rapid screening test to determine HIV exposure 99% accuracy uses only one drop of blood results available in 20 minutes

what is screened in blood products

HIV 1&2, HEP B&C, WEST NILE, TRYPANOSOMA CRUZI,

Phase 1: Binding(Attachment)

HIV binds to receptors on surface of CD4 cell *CCR5 antagonist *Post-attachment inhibotors

Phase 2: Fusion

HIV envelope and CD4 cell membrane fuse, which allows HIV to enter the CD4 cell *fusion inhibitors

Opportunistic Diseases

Histoplasmosis(fungal infection) Isosporiasis(parasite) chronic intestinal <1month Kaposi sarcoma- rare skin cancer Lymphoma, multiple forms Mycobacterium avium complex(causes TB and Leprosy Pneumocystitis jiroveci pneumonia(fungal infection in lungs pneumonia, recurrent Salmonella(bacteria) septicema,recurrent contaminated food and water Toxoplasmosis(parasite/protozoa class) of brain- cat feces wasting syndrome due to HIV

HIV in pregnancy

In US 30% of infected mothers will transmit to infants 50% to 70% of transmissions occur late in utero or intrapartum

Phase 6: Assembly

New HIV proteins and HIV RNA move to the surface of the cell and assemble into immature noninfectious HIV

Six Classes of ART used

Nucleoside reverse transcriptase inhibitors(NRTIs) Non-nucleoside reverse transcriptase inhibitors(NNRTIs) Protease inhibitors(PI) Integrase strand transfer inhibitors Fusion inhibitors CCR5 antagonists(also referred to as entry inhibitors)

What is given after exposure to HIV

PEP

How can a mother prevent spreading HIV to baby during pregancy

Take ART(antiretroviral therapy)

Postexposure prophylaxis (PEP)

Treatment administered to an individual after exposure to an infectious disease to prevent the disease

Antiretroviral Therapy (ART)

a combination of several medications prescribed for people who are HIV-positive to delay the onset of AIDS

Opportunistic Infections/cancers

account for a ;large portion of deaths related to HIV

AIDS( Acquired Immunodeficiency Syndrome)

acronym used to describe the end stage of the spectrum of HIV infection

More likely to be diagnosed with HIV

african americans

HIV is NOT spread by

air, water, insects, saliva, tears, sweat, casual contact, sharing dishes, closed-mouth kissing

Nurse role in coping

assess coping styles encourage healthy patterns of coping encourage patient to focus on positives aid pt in controlling anxiety use therapeutic communication

what effects does aids have on immune system

attacks cd4 helper cells or t cells, when left untreated minor infections could become severe

HIV takes over host

binding-attaches to cell receptor fusion-hiv fuses to cd4 cell reverse transcription- hiv releases enzyme to convert to DNA replication-uses cd4 to replicate hiv protein assembly-new hiv moves to the surface budding-newly formed hiv leaves cd4 cell

Immunosuppression

having weakened immune system and unable to fight infections

Mental Health Professional

helps HIV/AIDS patients with denial helps care for mental health

Possible Treatments for HIV

can be controlled with use of antiretroviral meds some opportunistic infections can be prevented with prophylaxis HIV is not curable; only treatable

nurse must stress pts who take hiv meds

continue prescription until finished, do not ration, infection will resist if not taken properly

pneumocytic diroveccia

cough(non productive), rapid breathing, fever, weight loss

other infections that are important to test for in HIV pt

hep c/ syphilis

To gain weight

high calorie diet

High prevalence rates since 2000

hispanics

enzyme-linked immunosorbent assay (ELISA)

detects antibodies to HIV proteins saliva and blood are used for testing less specific than western blot test possible false-positive reactions

HIV-RNA or viral load

determines the strength of the virus measurement of the amount of viral RNA in the blood stream

Risk Factors

homosexual men (highest number of HIV/AIDS patients Hispanics and african americans disproportionately infected African American adults/ adolescents 10 times more likely to be diagnosed than Caucasian

Nutrition related to hiv

increase in protein intake, high calorie, high potassium, low residue, foods that are easy to swallow when dysphagia is present and avoid spicy or acidic food

1996

increase in use of HAART (highly active antiretroviral therapy)

HIV

infectious human retrovirus; commonly invades T cells and B cells

ELISA

enzyme-linked immunosorbent assay; detects antibodies in the blood

Nurses

establishes rapport treat in nonjudgemental manner prevent infection provide education encourage adherence to medication regimen

Function of T cells and B cells

fight infection produce antibodies for specific immune responses

Social Worker

focus on pointing patient to needed resources case manager works for social worker in planning/meeting patient needs

Western Blot Assay

follow up to Elisa Seropositive testing More specific protein and expensive than Elisa

Pre-exposure prophylaxis (PrEP)

for people who do not have HIV but are high risk prevention of HIV infection pill taken every day must test negative before you start Brands: truvada-contains 2 meds tenofovir/emtricitabine

Phase 3: Reverse Transcription

inside CD4 cell. HIV releases and uses transcriptase(HIV enzyme) to convert its genetic material HIV RNA INTO HIV DNA. This conversion allows HIV to enter the CD4 cell nucleus and combine with the cells genetic material *Non-nucleoside reverse transcriptase inhibitors(NNRTIs) *Nucleoside reverse transcriptase(NRTIs)

Phase 4: Integration

inside the CD4 cell nucleus, HIV releases integrase(HIV enzyme). HIV uses integrase to insert its viral DNA into the DNA of the CD4 *Integrase Inhibitors

Commonly overlooked problem in females related to hiv infections

invasive cervical cancer

HIV- Stage 2

known as clinical latency often asymptomatic (no symptoms) low levels of virus present in blood

CD4 count for HIV

less than 500

What does HIV treatment limit

limits viral load/ immune system damage

HIV wasting

loss of body mass caused by disturbance in metabolism, interferes with nutrients increase opportunistic infection 10% body weight loss, diarrhea, weakness over 30 days intestine absorption decrease decrease testosterone in men

Its important for nurses to teach caregivers of HIV pts

modes of transmission for HIV

Oral Candidiasis

most common infections seen in individuals with early symptomatic disease

S/S of HIV

muscle/joint pain, weight loss, sore throat, night sweats, thrush, lesions, diarrhea, unexplainable fever and fatigue

Less common HIV transmission

needle sticks, receiving blood transfusion, eating prechewed food from hiv person, being bitten by a person, contact between broken skin

Main Symptoms of AIDS

neurological -encephalitis -Meningitis Eyes -Retinitis Lungs -Pneumocystis -Tuberculosis -Tumors Gastrointestinal -Esophagitis -Chronic Diarrhea -Tumors

Phase 7: Budding

newly formed immature noninfectious HIV pushes itself out of the host CD4 cell. New HIV releases protease. Protease acts to break up the long protein chains that form the immature virus. The smaller HIV proteins combine to form mature infectious HIV *Protease inhibitors (PIs)

Palliative Care

not with hospice enables patient to achieve the highest level of comfort focus on spiritual, psychological, social, physical needs

HIV wasting management

nutritional supplements increase protein enternal supplement_NG/PEG TPN

Vertical Transmission

transmission from mother to fetus during pregnancy, delivery, or breastfeeding

Pneumocytitis jiroveci (formerly carinii)

unusual pulmonary disease caused by fungus that infects people with suppressed immune system.

Western Blot Testing

used to identify specific amino-acids sequences in protein

Treatment as Prevention(TasP)

uses of antiretroviral(ARV) meds to prevent HIV transmission taken directly as prescribed regular follow up care regular viral load tests to ensure viral load is staying undetectable